Why Advocate For Consumer Choice in Health Care?

There is no shortage of important topics in health care; the U.S. faces thousands of challenges, from the prevalence of childhood obesity and hospital infection rates, to the affordability of new specialty medicines and end-of-life care. Our delivery system is far more expensive and far less safe and effective than it could be. Providers deliver care of ever-increasing complexity within brief, often-rushed encounters, leaving limited time for dialog. So, why invest resources and attention on an individual’s preferences about treatment?

No one is better positioned than patients and their families to guard against the nearly 100,000 estimated preventable deaths per year from medical errors. Indeed, a recent study found that patients who reported the highest levels of active participation in their care had half the rate of medical errors in the hospital as those with low participation. (9)

While clinical standards of care serve a useful purpose, in many cases those standards do not incorporate individual needs and preferences. Evidence suggests that doctors routinely misjudge what patients want. When asked independently about their primary health care goals and intentions to meet those goals, pairs of doctors and patients disagree more often than not. (10) When in agreement, treatments result in better outcomes and better adherence to doctor recommendations. (11)

Furthermore, when considering their own health, patients often weigh benefits and harms differently than their doctors. When provided with unbiased information about pros and cons of discretionary procedures, as many as 25 percent of patients scheduled for surgery choose an alternative treatment, resulting in better functional outcomes and satisfaction. (12)

Because of avoided surgeries, higher rates of adherence, prevented medical errors, and better condition management that accompany active participation, consumer choice also results in lower overall costs. Also, due to individual differences in preference about such things as quality of life and length of life, economists estimate huge potential savings from choosing cost-effective options based on individual preferences rather than choosing one “most effective standard” approach across all patients. (13)

Numerous public agencies have called for increased consumer involvement in care decisions and greater transparency in cost and quality, including the Agency for Healthcare Research and Quality, Institute for Safe Medication Practices, National Patient Safety Foundation, and The Joint Commission’s Speak Up initiative. (14, 15, 16, 17) Additionally, national health plans, such as Aetna, have created websites to allow members to compare price a quality among providers and hospitals. (18) The rising profile of consumer involvement is also indicated by the quickening pace of business innovation: numerous startups, such as Castlight Health, change: healthcare, Healthcare Blue Book, and Monocle Health Data, are developing new tools, data sources, presentation formats, and communication strategies to put the right information in consumers’ hands at the right time. (19, 20, 21, 22)

Despite a growing body of evidence about the important role consumers can and should play in improving health care, the system often discourages active participation. Too many patients are reluctant to ask providers to take known precautions. (23) The leader of the Centers for Medicare and Medicaid Services, Dr. Donald Berwick, acknowledges that the much-touted “patient-centered” model now being advanced still sacrifices patient preferences in favor of provider convenience or outdated procedural rules. (24)

There remains a need for science that identifies factors that encourage and speed adoption of patient involvement, and evaluates programs and tools designed to facilitate patient choice-making. As more consumers are encouraged to play significant roles in selecting and paying for their care, businesses and health plans need better information about how to present unbiased information and encourage prudent decisions. Altarum’s Center for Consumer Choice in Health Care intends to help build that scientific knowledge base.

There has never been a more critical time for citizens to influence the future of health care. Current health care cost trends are unsustainable; medical error rates are unacceptable; obesity and inactivity rates continue to grow to record levels; and clinical quality remains inconsistent. Only one stakeholder group has the ability to reverse all these trends: consumers who become active participants in care decisions.

At Altarum, our Center for Consumer Choice in Health Care is supporting a collaboration to develop real-time social media indicators of consumerism attitudes and activities in health and health care. Stay tuned for upcoming developments.